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2. Every effort will be made to begin services on your requested start date; however, some orders may be held until the following business day. All requests for service received after 1:00 p.m. will be processed the next business day after your application has been received and approved, based on field staff availability. 

   Services cannot be started on any closed weekends or holidays. 

   Note: All fields must be filled out.  If not applicable please enter "NA". Thank you. 

6. APPLICANT INFORMATION
8. Name*
9. Phone Number*
10. Email Address*
12. Service Address*
14. Mailing Address*
16. Mailing City/State/Zip*
18. Driver's License or Social Security Number*
19. Date of Birth*
21. Home Phone*
22. Cell Phone*
24. Name of Employer*

    Please list retired or student if applicable.

25. Number of Occupants*
27. Receive Utility Notifications*

    1. Yes
    2. No
28. Enroll in Paperless Billing via Email*

    1. Yes
    2. No
29. Have you previously had water service with the City of Cotati?*

    1. Yes
    2. No
31. Owner or Renter*

    1. Owner
    2. Renter
32. Date to Start Service
    Date to Start Service

    Services cannot be started Friday-Sunday or holidays.

36. Property Owner Information

    If you are the property owner please provide again herein for our records.

    To remain compliant with CMC 13.03.260, the City is required to obtain written consent from property owners for the City to directly bill the renters.

38. Property Owner Name*
39. Property Owner Email Address*
41. Property Owner Address
43. Property Owner City
44. Property Owner State
45. Property Owner Zip Code
47. Property Owner Phone Number*
48. Property Owner Fax Number - If Applicable
52. Certifications and Acknowledgement
54. Liability*

    I/We are requesting the City of Cotati to turn on water at the above service address and understand that if all water using appliances are not completed closed, or if there are any leaks, the premises may suffer water damage. I/We hereby accept full responsibility for such damage and agree to indemnify, defend and hold harmless the City, its officers and employees from and against any and all loss, liability, expense, cost claims, demands, suits and damages, including attorney's fees arising directly or indirectly related to the turning on of water service at the above service address, except for a liability arising from the sole negligence or wilful misconduct of the City. 

    1. I Agree
56. Acknowledgement*

    I/We, the undersigned, hereby apply for water service at the above service address. I/We agree to use the water service and pay all rates and charges for water service in accordance with Cotati Municipal Code, and to comply with all water regulations of the City of Cotati. I/We understand that the City shall have the right to terminate water service if any of the foregoing information is determined to be false or untrue or if the required security deposit and/or monthly bills are unpaid. I/We represent and warrant that I am authorized to sign this application. I/We have read the foregoing and declare under the penalty of perjury under the laws of the State of California that the foregoing is true, correct, and complete to the best of my/our knowledge. 

    1. I Agree
58. Cancelation of Services

    I understand it is my responsibility to notify the City when services at the above listed service address need to be cancelled. I will remain responsible for all water services and charges until I have filed a stop services form. If a stop service form is not received by the City all charges will continue to accumulate on the account until such notice has been received and accepted by the City. Please acknowledge by initialing below. 

    1. I Agree
60. Deposit

    A deposit of $200 is required of all new Cotati residents in addition to a $35 non-refundable administrative services fee. This deposit and initial fee will be added to the first bill service. 

    The security deposit shall be applied to the closing bill upon the discontinuation of services and any remaining credit will be refunded. If you move to a new city service location, a new account will be opened and a new deposit may be required to start services unless the applicant satisfies the City's exemption criteria.

    Please Submit for acknowledgment:

Leave This Blank:


62. 1. Receive an email copy of this form.
63. Email address

    This field is not part of the form submission.

64. Submit

* indicates a required field